End-of-life care in Brazilian Pediatric Intensive Care Units

Abstract Objective Most deaths in Pediatric Intensive Care Units involve forgoing life-sustaining treatment. Such deaths required carefully planned end-of-life care built on compassion and focused on palliative care measures. This study aims to assess topics related to the end of life care in Brazilian pediatric intensive care units from the perspective of a multidisciplinary team. Method The authors used a tested questionnaire, utilizing Likert-style and open-ended questions. After ethics committee approval, it was sent by email from September to November/2019 to three Pediatric Intensive Care Units in the South and Southeast of Brazil. One unit was exclusively dedicated to oncology patients; the others were mixed units. Results From 144 surveys collected (23% response rate) 136 were analyzed, with 35% physicians, 30% nurses, 21% nurse technicians, and 14% physiotherapists responding. Overall, only 12% reported enough end-of-life care training and 40% reported never having had any, albeit this was not associated with the physician's confidence in forgoing life-sustaining treatment. Furthermore, 60% of physicians and 46% of other professionals were more comfortable with non-escalation than withdrawing therapies, even if this could prolong suffering. All physicians were uncomfortable with palliative extubation; 15% of all professionals have witnessed it. The oncologic team uniquely felt that "resistance from the teams of specialists" was the main barrier to end-of-life care implementation. Conclusion Most professionals felt unprepared to forego life-sustaining treatment. Even for terminally ill patients, withholding is preferred over the withdrawal of treatment. Socio-cultural barriers and the lack of adequate training may be contributing to insecurity in the care of terminally ill patients, diverging from practices in other countries.

Reflection on the Relationship between the Ethical Principles and Rules of Biomedical Science and Technology / 中国医学伦理学

Clarifying the relationship between ethical principles and rules is the key to promote the legitimate governance of scientific and technological ethics. Ethical principles and rules, as the two basic elements of science and technology ethics, are both different and related. The ethical principles are the basis and direction of the formulation of the ethical rules which are the most direct expression of following the ethical principles and an effective means to improve the effect of ethical governance. Among them, ethical standards are the general standard rules with strong universality. Based on the analysis of the relationship between the ethical principles and the ethical guidelines, this paper put forward the expression mode and reasonable application of science and technology ethical principles in the ethical rules, so as to promote the improvement of the national ethics governance system of biomedical science and technology.

De la ética médica tradicional a la bioética médica / From traditional medical ethics to medical bioethics

Después de una reseña introductoria de la medicina como ciencia y como arte, se muestra el desarrollo histórico de la ética médica desde los albores de la medicina, con su carácter mágico y religioso; su evolución y enriquecimiento a lo largo de la cultura griega, los cambios sucedidos en la edad media, moderna y contemporánea, con la naturalización, cientifización y tecnificación de la medicina, originando conflictos biomédicos que la ética médica tradicional es insuficiente para enfrentar. Surge entonces la bioética en la década de los años 70. Se ilustra su inicio como un área de reflexión multidisciplinaria de integración de temas medioambientales, sociales y médicos, que con el paso del tiempo llega a ser esencialmente una bioética médica. Se recuerda su origen y desarrollo inicialmente en los EE. UU. de NA, luego en Europa, Latinoamérica y el resto del mundo, hasta su evolución y situación actual, en la que surgen cuestionamientos a su teoría principialista original, aportando nuevas concepciones, como la de justicia social, generada en Sudamérica.

After an introductory review of medicine as a science and art, it is shown the historical development of medical ethics, since the down of medicine, with its magical and religious character; its evolution and enrichment through greek culture, changes occurred in medieval, modern and contemporary ages, with its medical naturalization, scientification and tecnification, originating biomedical conflicts that traditional medical ethics is insufficient to face. Bioethics then arises in the 70 decades. It is shown its origin as a multidisciplinary and integrative reflection área of environmental, social and medical topics, that with the passage of times becomes essentially a medical bioethics. It is remembered his origin and development initially in USA, then Europe, Latinamerica and the whole world, until its evolution and current situation, when questions arise to its principlist original theory, bringing new conceptions as social justice, originated in Southamerica.

Comparative Study of Nursing Students Consciousness of Biomedical Ethics and Attitudes toward Human Tissue Donation and Transplantation According to Participation in Anatomy Camp Program / 체질인류학회지

The purpose of this study was to identify the consciousness of biomedical ethics and attitudes toward human tissue donation and transplantation among participants and non-participants in the anatomy camp program. Data collection is made from one hundred and eighty-two students who were enrolled in one university nursing department, in B metropolitan city. Ninety-six students participated in the anatomy camp program, while eighty-six students did not participate in the anatomy camp program. The total mean scores of consciousness of biomedical ethics between participants (2.03/4) and non-participants (1.96/4) were significantly different (t=2.217, p≤.028). And the total mean scores of attitudes toward human tissue donation and transplantation between participants (3.49/5) and non-participants (3.31/5) were significantly different (t=4.579, p≤.000). There were statistically significant differences between two groups in sub-categories of consciousness of biomedical ethics: organ transplantation, artificial insemination.

Eutanasia en Chile: una discusión pendiente / Euthanasia in Chile

Euthanasia is a complex medical procedure. Even though end of life decisions are common situations in health practice, there is a lack of consensus about their terminology. In this manuscript, the main concepts about this issue are defined and delimited; including active and passive euthanasia and limitation of therapeutic effort. Then, a revision is made about the international experience on euthanasia, to then go through the Chile’s history in euthanasia and the population’s opinion. In Chile, euthanasia is an act that has been removed from the social dialogue and legislation. In order to have an open discussion in our population about the issue, the debate has to be opened to the citizens, accompanied by clear medical information about the procedure.

Study on the Consciousness of Biomedical Ethics and the Influential Factors among Nursing Students in Advanced Vocational College / 中国医学伦理学

Objective: To investigate the status of the consciousness of biomedical ethics and its influential factors among nursing students in advanced vocational college and to provide evidence for the development of bio-medical ethics education and research. Methods:A total of 550 nursing students from an advanced vocational col-lege were surveyed on their personal information, the consciousness of biomedical ethics and its influential factors using the self-constructed questionnaires, e. g. , general information questionnaire and consciousness of biomedic-al ethics questionnaire. Results: The mean of the consciousness of biomedical ethics among nursing students is 2. 78, which was associated with age, length of schooling, whether get the related information or not and whether discussed about the topic with teachers and families or not. Spearmen correlation analysis showed that age, grades of nursing students has effect on the consciousness of biomedical ethics. Conclusion:The views of biomedical eth-ics among nursing students in advanced vocational college need to be clarified. A variety of ways should be used to guide the nursing students to the deep understanding of ethical problems and to help them have positive awareness of biomedical ethics.

Is Autonomy a Universal Value of Human Existence? Scope of Autonomy in Medical Practice: A Comparative Study between Western Medical Ethics and Islamic Medical Ethics

The practice of contemporary medicine has been tremendously influenced by western ideas and it is assumed by many that autonomy is a universal value of human existence. In the World Health Report 2000, the World Health Organization (WHO) considered autonomy a “universal” value of human life against which every health system in the world should be judged. Further in Western bioethics, patient autonomy and self -determination prevails in all sectors of social and personal life, a concept unacceptable to some cultures. In principle, there are challenges to the universal validity of autonomy, individualism and secularism, as most non-Western cultures are proud of their communal relations and spiritualistic ethos and, thereby imposing Western beliefs and practices as aforementioned can have deleterious consequences. Religion lies at the heart of most cultures which influences the practice patterns of medical professionals in both visible and unconscious ways. However, religion is mostly viewed by scientists as mystical and without scientific proof. Herein lies the dilemma, whether medical professionals should respect the cultural and religious beliefs of their patients? In this paper we aim to discuss some of the limitations of patient's autonomy by comparing the process of reasoning in western medical ethics and Islamic medical ethics, in order to examine the possibility and desirability of arriving at a single, unitary and universally acceptable notion of medical ethics. We propose a more flexible viewpoint that accommodates different cultural and religious values in interpreting autonomy and applying it in an increasingly multilingual and multicultural, contemporaneous society in order to provide the highest level of care possible.

Influence of Moral Sensitivity and Ethical Values on Biomedical Ethics Awareness of Nursing Students / 한국간호교육학회지

PURPOSE: This study was performed to investigate the effects of moral sensitivity and ethical values on biomedical ethics awareness of nursing students. METHODS: A descriptive survey design was used for this study. The participants were 324 nursing students from S University located in J city. The data were collected through a questionnaire survey done from September 30 to October 18, 2014. Data were analyzed using a t-test, ANOVA, Scheffe's test, Pearson correlation coefficients, and stepwise multiple regression. RESULTS: The factors influencing nursing students' biomedical ethics awareness were identified as moral sensitivity(beta=.34), ethical values(beta=.11), awareness of Korean nurses' declaration of ethics(beta=.15), religion(beta=.14), and religious activity(beta=.12). Five factors explained 10.8% of nursing students' biomedical ethics awareness. CONCLUSION: The results of this study can be used to develop further educational programs on the moral sensitivity and ethical values for enhancement of nursing students' biomedical ethics awareness.

Recognition of Patients, Families, Nurses, and Physicians about Clinical Decision-making and Biomedical Ethics

PURPOSE: To identify the recognition of patients, families, nurses, and physicians about clinical decision-making and biomedical ethics. METHODS: Data were collected from October 23 to 30, 2012 using the structured questionnaires. A total of 200 data were analyzed using SPSS 20.0 version. RESULTS: Response about 'who should receive the first notice of a cancer diagnosis?' was significant difference statistically. Cancer patients had preferences to be notified their diagnosis first. Patients responded the person who made decision of treatment options would be physician first and then themselves. Families, nurses, and physicians answered that decision-maker would be both of patient and family. All four groups answered that the person who made decision about care-giver after discharge was patient and their family. Nurses and physicians who didn't aware of the advanced directive were over 30.0%, and patients and family who didn't aware of that were over 60.0%. Lastly, the rate of positive answer about making attempt of advanced directive after legalization was over 80.0%. CONCLUSION: Patient's attitude about making decisions is different from family's attitude. Nurses and physicians have to put emphasis on the patient's autonomy & self-determination and family members' needs.

Biomedical Ethics Policy in Korea: Characteristics and Historical Development

Ethical consideration is an inseparable part of policy-making in modern society. Biomedical ethics is an interdisciplinary study of ethical issues that result from advances in medical practices and research. Because these issues often arise at the bedside, society must provide solutions or judgments that are effective and applicable. Thus, the development and progress of biomedical ethics has been made possible via the cooperation of experts from diverse backgrounds. The biomedical ethics discourse should not be seen as a conflict between values but as a collective activity for problem-solving. To support this perspective on ethics discourse, a historical perspective on biomedical ethics in Korea was given emphasis on the participants and their perspectives. Major cases and the changes resulting therefrom were discussed with the agenda proposed. The Korean situation with respect to ethics development shows the interactions between groups participating in policy development and its collaborative nature.

Consciousness of Biomedical Ethics in Nursing Students and Non-Nursing Students / 기본간호학회지

PURPOSE: The purpose of this study was to provide basic data necessary for educating nursing students by establishing a desirable sense of ethics values. METHOD: In this descriptive research, 101 nursing students and 191 non-nursing students (in other health related fields) from Daejeon City were selected. Tools used for data analysis were descriptive statistics, t-test, one-way ANOVA, Scheffe test and step wise multiple regression with SPSS/WIN 12.0 version. RESULTS: Average scores for consciousness of biomedical ethics in nursing students was 2.94, and in non-nursing students, 2.77. When differences in the consciousness of biomedical ethics of nursing and non-nursing students were compared, nursing students had significantly higher scores for artificial abortion, artificial insemination, prenatal diagnosis of fetus, right to life of newborn, euthanasia, organ transplantation and human biotechnology, but significantly lower for brain death. Variables which influenced consciousness of biomedical ethics were religion and economic status in the nursing students and intent to attend a class in biomedical ethics, quantity and quality of biomedical ethics in the current curriculum and religion in the non-nursing students. CONCLUSION: Continuing educational programs need to be considered and attention given to the significant variables that can promote consciousness of biomedical ethics in nursing students.

Que es bioética? / What is bioethic?

El desarrollo de la ciencia y la tecnología han cambiado nuestra forma de vivir y nuestra concepción de la vida. Este desarrollo ha tenido repercusiones muy positivas, pero a la vez, han surgido serios problemas éticos que debemos conocer y enfrentar. Hoy sabemos que los efectos negativos sobre el medio ambiente derivados del uso de la biotecnología, ponen en peligro la subsistencia de la vida en el planeta. En el campo específico de la medicina; han surgido serias dificultades para la adecuada selección de las indicaciones médicas; se ha creado un importante abismo entre el conocimiento que hoy tenemos y la aplicación de estos conocimientos en la práctica clínica; se han incrementado los errores, los costos y la inequidad en la atención médica. Existen serias dudas en relación con el uso de las nuevas técnicas de fertilización. A la vez que en muchas ocasiones no sabemos si debemos tratar o no tratar ciertos pacientes con enfermedades en etapa terminal o en situaciones que los dejarían con serias incapacidades físicas y mentales. La cardiología ha sido una de las especialidades más beneficiadas con el desarrollo científico-tecnológico, lo cual sin dudas ha tenido repercusiones muy positivas, y en consecuencia, también enfrenta importantes problemas éticos. La bioética constituye un espacio la reflexión, deliberación y búsqueda de las mejores soluciones a los problemas éticos surgidos del desarrollo y aplicación de la biotecnología, desde una perspectiva plural y orientada a un diálogo por la vida y el respeto a la dignidad y derechos del ser humano.

Developments in science and technology have changed aur way of life and aur understanding of life. These developments have had a very positive impact, but at the same time, serious ethical problems have arisen that we have to understand and face. We know today that negative effects on the environment arising from the use of biotechnology, endanger the survival of life on the planet. Specifically in medicine, serious difficulties have arisen for the proper selection of medical applications; a significant gap has arisen between the knowledge we have today and the application of knowledge in clinical practice; there is an increase in errors, expenditures and inequity in health care. There are serious doubts about the use of new fertility techniques. There are times when we do not know whether or to treat certain patients with end-stage disease particulary in situations that would leave them with serious physical and mental disabilities. Cardiology has been one of the speciclties which has benefited from scientific and technological development, which has ubdoubtedly had a very positive impact, and consequently it also faces important ethical challenges. Bioethics creates room for reflection, debate and a search fot the best solutions to the ethical problems arising from the development and application of biotechnology, from a pluralistic perspective to a dialogue aimed at dignity and human rights.

A History and Philosophy of Bio-Medical Ethics Seen from a Dentist's Point of View / 의사학

When we think about ethics or morals, we tend to look at them from the viewpoint of here and now. Actual implications of then and there, however, could be different. That is why we should study history of bio-ethics along with philosophy involved in it. Bio-medical ethics is situated in spatial and cultural dimension as well as temporal and historical. Dentistry has been in a peculiar situation in that although it has evolved from the same root as medicine it has become separate discipline. Ethical implications of dentistry, however, share the historical and philosophical background with its mother discipline, i.e., medicine, surgery, barber-surgery and even smithery. This paper tries to grasp the main ideas of bio-medical ethics from the ancient Greek and China and picks up three of them as guiding principles, i.e., deontology and teleology from the west and self-cultivation from the east, It also tracks down the contents of modern biomedical ethics; from etiquette to ethics, from morals to contract (ethics of autonomy), and ethics of professional responsibility. Finally it reviews and analyzes two different traditions of dental professional regulation from the legal and ethical point of view (U.S. and Europe), and proposes a new direction for the construction of dental ethics in Korea.

Experiences and Lessons of an On-line Biomedical Ethics Course / 한국의학교육

The Korea's first-ever on-line biomedical ethics education class began in September 1999. The class, one of the 18 on-line lectures offered in the Fall Semester, 1999 by Seoul National University Virtual Campus, allows the Korean general public the opportunity to attend an SNU lecture. Although the discussion sites are limited to the randomly selected 40 students taking the 16-week-long course, any one can read the instructor's lecture on the Internet. (http://snuvc. snu.ac.kr/class/h601) The topics of this course include abortion, euthanasia, organ transplantation, human cloning and etc. As members of the team responsible for this unprecedented biomedical ethics education program in Korea, we, the authors, report the experiences that the team went through both in preparing for and running the course. We concludes from the experience that we had that 16 weeks are too long for an on-line course without academic credits or sufficient number of tutors. Also, we suggest that in the near future the on-line biomedical ethics course should be able to be used for continuing education of such medical professions as medical doctors and nurses.

Compilation and publication of Conspectus of Medical Ethics——the first unified textbook / 中国医学伦理学

The publication of the first professional medical ethics textbook "onspectus of Medical Ethics "trongly depended on the attempt of curriculum reform under the spirit of "Emancipate the mind and seek truth from facts".Looking back to the process of compilation and publication of this textbook,the huge significance of "reform and opening up" in the history of textbook construction and discipline development of biomedical ethics in China was highly appreciated.